Wisdom Teeth

The third molars on each side of the upper and lower jaws are known as wisdom teeth. They are the last permanent teeth to erupt. It is possible for some or all of one’s wisdom teeth to never come in, but most people have them. It is even possible to have more than four. Many times wisdom teeth aren’t visible because they become impacted under the gums.

If you can see three permanent molars in each back section of your mouth, this means that you do have wisdom teeth. But, if they are under the tissue, they are only possible to see with an x-ray image. Most wisdom teeth can be spotted erupting through the gums between the ages of 16 and 23. Wisdom teeth that are just coming through can cause a dull throbbing in the back of the jaws, even before they can be seen visually.

Do all wisdom teeth need to be pulled?

When wisdom teeth cause pain, sometimes the person can avoid extracting them with a few changes to the surrounding tissues or modifications to their oral hygiene. It is fairly common for someone to have pain from biting down on a small flap of swollen gum tissue that barely covers the back of the wisdom tooth. Sometimes this tissue can simply be removed as long as there is otherwise enough room for the wisdom tooth to fully erupt. Additionally, a person can avoid potential gingivitis or infection around the wisdom teeth with a change in the angle of tooth brushing and an increase of flossing both in front and behind the teeth.

Even though there are several things one can do to avoid it, there are many situations in which tooth extraction is absolutely necessary. First off, sometimes wisdom teeth can erupt at such an angle that the adjacent molar is difficult to keep clean. Consequently, the position of the wisdom tooth may cause gum disease or deep periodontal pockets and should be removed before too much damage is done to the much more critical second molars. Secondly, if the wisdom teeth are trying to erupt and there isn’t enough room for them, significant pressure can be put on the surrounding teeth and gums. Many times this pressure results in jaw pain or stiffness; tooth pain; or bad headaches. In this case, the wisdom teeth must be removed. Even if the wisdom tooth has erupted through the tissue but is not putting any pressure on the neighboring teeth, extraction should still be considered. Since wisdom teeth are so far back in the mouth, they are often difficult to clean thoroughly. If they do start to decay, it is usually best to remove them instead of fixing the wisdom teeth with a root canal, dental filling or same day dental crown.

What are the signs of an infected wisdom tooth?

One of the most common reasons for an emergency wisdom tooth extraction is pericoronitis, which is inflammation of the gums surrounding the crown of a tooth. This typically occurs when there is not enough room for any more teeth in the lower jaw.  Indications that the area is infected include red, swollen gum tissue; pain with biting; a bad taste or smell; and sometimes pus oozing from the area. Sometimes the infection will lead to swelling of the gums or cheek, which can even cause an intense ear ache. When infection is suspected, it is very important to get examined by a professional so that it can be treated accordingly.

If a person is experiencing swelling, infection, fever, difficulty breathing or intense pain, it is imperative that the wisdom teeth are removed as soon as possible. A warm saltwater rinse or over-the-counter painkillers can be used to lessen the tooth pain until further treatment can be obtained. Antibiotics may also be prescribed to help keep an infection from getting worse or spreading.

Once it is clear that a wisdom tooth needs to be removed, the doctor will sedate the area with local anesthesia so that any major discomfort can be avoided. Then, the doctor will perform a minor surgery where the tissue and bone around the tooth are removed. This is done so that the wisdom tooth can be easily extracted from the socket. A minor surgery is then performed where the tissue and bone around the wisdom tooth are removed so that the tooth can be cleanly extracted from the socket. The remaining gap is usually closed by several sutures to promote healing of the overlying tissue. Most of the time our doctors will use dissolvable stitches that come out on their own after about a week. If a patient is more comfortable being ‘a sleep’ for their extraction, we are also able to make references to local oral surgeons.